Project Summary/Abstract The applicant Udo Hoffmann MD MPH is a Professor of Radiology at Harvard Medical School and the Chief of the Division for Cardiovascular Imaging in the Department of Radiology at MGH. Dr. Hoffmann has established a patient oriented research (POR) program that combines innovative translational, clinical, and outcomes research methods to demonstrate the value of advanced cardiovascular imaging. Dr. Hoffmann has published approximately 380 peer reviewed papers, among them many in premier medical journals and has received continued independent, peer-reviewed POR NIH funding since 2005. He is among the very few faculty members at Harvard Medical School who are both the PI and Director of a highly successful NHLBI funded T- 32 program (Cardiac MR and CT Research) and a recipient of a K24. Dr. Hoffmann has successfully mentored more than 60 clinical investigators, most of which currently hold faculty positions in major academic centers and actively perform POR. Moreover, Dr. Hoffmann has successfully accomplished all mentoring and scientific goals of the first K24 award period. Overall, these achievements document Dr. Hoffmann's long standing passion and commitment to POR. His excellent publication, funding, and mentoring record together with his current and planned research support provide an excellent foundation to accomplish the aims of this competitive renewal of the K24 Award ?Cardiovascular Imaging in Ischemic Heart Disease?. Dr. Hoffmann proposes a mentoring and research plan that utilizes the synergies of past, ongoing, and future highly innovative independent research projects with educational and training opportunities offered by the cardiac MR CT PET Program, the T32 training program in cardiovascular imaging, the Harvard CTSA, and the Harvard School of Public Health. The specific aims addressing the charge of the K24 Award are to enable Dr. Hoffmann to: 1) dedicate 25% of his time to mentor clinical investigators based on NIH or equivalent funded projects in ?Cardiovascular Imaging in Ischemic Heart Disease?, 2) to mentor junior and mid-career clinical investigators with the goal to develop them into clinical researchers who can successfully compete for peer reviewed grants, and 3) to continue to expand a POR program that combines translational, clinical, and outcomes research to develop future leaders in clinical research in cardiovascular imaging and beyond. The research plan encompasses four specific aims: 1) To determine the effects of statin treatment on coronary atherosclerosis in HIV patients in 800 patients with HIV randomized to statin therapy vs. placebo, 2) To determine whether high risk coronary plaque predicts cardiovascular events in 4600 patients with clinical suspicion of CAD, 3) To determine the cost effectiveness of CT FFR in patients with stable and acute chest pain, and 4) To use Radiomics to identify novel imaging markers predicting cardiovascular events in participants of the Framingham Heart Study.